GIHSN-China s experience & Results of season Beijing, China
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1 GIHSN-China s experience & Results of season Beijing, China 1. Chinese Center for Disease Control and Prevention 2.WHO Collaborating Centre for Infectious Disease Control and Epidemiology, School of Public Health, The University of Hong Kong
2 Study management summary District Chang Ping Huai Rou Da Xing MiYun Fang Shan Hospital Chang Ping Hospital Huai Rou Hospital People s Hospital of Da Xing Mi Yun Hospital Liang Xiang Hospital Category Tertiary Secondary Secondary Tertiary Tertiary Population 1,743, ,063 1,470, ,094 1,020,980 Hospital Beds Ward (Number of beds) Respiratory (42) Pediatric (45) ICU(10) Respiratory (55) Pediatric (38) Respiratory (66) ICU (37) Respiratory (46) Pediatric (32) ICU (12) Respiratory (74) Pediatric (60) ICU (12) Start Date 9 Sep Sep Dec Dec Apr
3 Features of GIHSN-Beijing Participating wards: respiratory,pediatric, intensive care units Recruitment started in October 2015 and stopped in May The influenza season is defined as periods during which cases tested positive for influenza for two or more consecutive weeks. Same case screening and recruitment criteria as the Core Protocol. Data collection: Interview & clinical records Vaccination status was determined by registry vaccination records in Beijing EPI Information Management System Online data management system is used Specimen collection: Two pharyngeal swabs were taken for all included cases. 3
4 Patient recruitment and case detection Number of Cases Mixed infection Influenza B/Victoria Influenza B/Yamagata Influenza A(H3N2) InfluenzaA(H1N1) pdm Year-week
5 Vaccination status determination Recruited Registry N=2,892 Name match N=1,817 Vaccinated: 320 Name not match N=1,075 Not : 1,497 M1: Not match by self-reported data Vaccinated: Not : 1, Unknown: 115 M2: Not match as un Vaccinated: 320 Not : 2,572 5
6 Patients recruited in season Characteristics Age group Test-positive (n=350) N (%) Test-negative (n=1,746) N (%) p-value 6m-4y 158 (45.1%) 669 (38.3%) y 58 (16.6%) 204 (11.7%) 18-59y 45 (12.9%) 320 (18.3%) 60y 89 (25.4%) 553 (31.7%) Male 188 (53.7%) 996 (57.0%) Chronic conditions 86 (24.6%) 539 (30.9%) Vaccination in Yes 47 (13.4%) 209 (12.0%) No 287 (82.0%) 1476 (84.5%) Unknown 16 (4.6%) 61 (3.5%) 6
7 Vaccine effectiveness by virus type Vaccine effectiveness Positive Positive not Negative Negative not VE (95% CI) M1 Influenza overall 47 (14.1%) 287 (85.9%) 209 (12.4%) 1476 (87.6%) -19.9% (-76.8%, 18.7%) Influenza A(H1N1) 26 (15.1%) 146 (84.9%) 209 (12.4%) 1476 (87.6%) -19.3% (-98.5%, 28.2%) Influenza A(H3N2) 15 (15.2%) 84 (84.8%) 209 (12.4%) 1476 (87.6%) -71.5% (-233.9%, 11.9%) Influenza A 13 (17.3%) 62 (82.7%) 209 (12.4%) 1476 (87.6%) -1.8% (-101.5%, 48.6%) Influenza B 21 (12.9%) 142 (87.1%) 209 (12.4%) 1476 (87.6%) -2.8% (-79.2%, 41.1%) M2 Influenza overall 47 (13.4%) 303 (86.6%) 209 (12.0%) 1537 (88.0%) -18.6% (-74.3%, 19.3%) Influenza A(H1N1) 26 (13.9%) 161 (86.1%) 209 (12.0%) 1537 (88.0%) -14.2% (-88.4%, 30.7%) Influenza A(H3N2) 15 (13.9%) 93 (86.1%) 209 (12.0%) 1537 (88.0%) -62.7% (-212.6%, 15.3%) Influenza A 13 (16.0%) 68 (84.0%) 209 (12.0%) 1537 (88.0%) 0.2% (-95.2%, 49.0%) Influenza B 21 (12.7%) 144 (87.3%) 209 (12.0%) 1537 (88.0%) -4.0% (-81.0%, 40.2%) 7
8 Vaccine effectiveness by age Vaccine effectiveness Positive Positive not Negative Negative not VE (95% CI) M1 6m-4y 5 (3.2%) 153 (96.8%) 14 (2.1%) 655 (97.9%) -42.4% (-344.4%, 54.4%) 5-17y 16 (27.6%) 42 (72.4%) 54 (26.5%) 150 (73.5%) -29.7% (-168.4%, 37.3%) 18-59y 1 (2.9%) 34 (97.1%) 9 (3.1%) 278 (96.9%) -4.4% (-787.5%, 87.7%) 60y 25 (30.1%) 58 (69.9%) 132 (25.1%) 393 (74.9%) -13.8% (-97.3%, 34.3%) Overall 47 (14.1%) 287 (85.9%) 209 (12.4%) 1476 (87.6%) -19.9% (-76.8%, 18.7%) M2 6m-4y 5 (3.2%) 153 (96.8%) 14 (2.1%) 655 (97.9%) -42.4% (-344.4%, 54.4%) 5-17y 16 (27.6%) 42 (72.4%) 54 (26.5%) 150 (73.5%) -29.7% (-168.4%, 37.3%) 18-59y 1 (2.2%) 44 (97.8%) 9 (2.8%) 311 (97.2%) -4.0% (-793.7%, 87.9%) 60y 25 (28.1%) 64 (71.9%) 132 (23.9%) 421 (76.1%) -9.3% (-87.0%, 36.1%) Overall 47 (13.4%) 303 (86.6%) 209 (12.0%) 1537 (88.0%) -18.6% (-74.3%, 19.3%) 8
9 Discussion Use of electronic patient data management and vaccination registry to improve data quality Effectiveness estimation of the trivalent vaccine for northern hemisphere in China (Beijing) is low. Mismatch between vaccine strains and circulating strains Data quality? (but this has not been an issue in previous years) Other factors? 9
10 Self-reported vs registry vaccination Registry Vaccinated Non- Unknown Sub-total Vaccinated % % 4 0.4% % Selfreported Non % % % % Unknown % % % % Sub-total % % % % 10
11 Virus detection by CNIC North South Largely similar virus circulation in northern and southern China Influenza B (Victoria lineage) predominant throughout season Much fewer influenza A(H1N1) and A(H3N2) viruses detected than B 11
12 Virus detection in China A(H3N2) WHO trivalent influenza vaccine recommendation for northern hemisphere an A/California/7/2009 (H1N1)pdm09-like virus an A/Switzerland/ /2013 (H3N2)-like virus (sub-clade 3C.3a) a B/Phuket/3073/2013-like virus (Yamagata lineage) Source: 12
13 Challenges Explanations for varied vaccine effectiveness estimates across seasons Methodological issues of studies Variations in population immunity due to different vaccination strategies and prior virus circulation history in different regions Cross-protection between influenza B lineages Site experience and results of season [City], [Country] 13
14 Acknowledgments Foundation for Influenza Epidemiology and GIHSN office Hongjie Yu, Luzhao Feng,Ying Qin from the Chinese Center for Disease Control and Prevention Staff working on the project from participating hospitals, Beijing CDC and district-level CDCs in Beijing 14
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